Common labor complication - PowerPoint Presentation

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Common labor complication

The labor and birth process is usually

straight forward

, but sometimes complications arise that

may

need immediate

attention.

Complications

can occur during any part of the labor process.

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Common labor complication

1.Failure to progress

2. Fetal distress

3

.Excessive bleeding

4

.Malposition

5

. Prolapsed umbilical cord

6 .

cephalopelvic

dis proportion

7 . Uterine rupture

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1. Failure to progress:

Prolonged labor, labor that does not progress, or failure to

progress is when labor lasts longer than expected.

Causes

-slow cervical dilations

-slow effacement

-

- large baby

-

- small birth canal or pelvis

-delivery of multiple babies

-emotional factors, such as worry, stress , and fear

-

Pain medications can also contribute by slowing or weakening uterine contractions.

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Management

1. Rupture

of

Membranes

artificially

using a tool made for that purpose

.

2. pain

relieving drugs

,suggest

that

consider

pain

treatment

,

such as an epidural

..

3. Oxytocin

is a natural stimulant of the uterine

muscle contraction

4. Delivery

Options

If labor does not progress despite other efforts, or if the baby starts showing signs of distress, operative delivery will

take..

Assisted vaginal delivery may be an option in situations where the baby is almost out of the birth canal during the pushing stage. A vacuum or forceps can be used to help the baby come out.

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2. Fetal distress

"Non-reassuring fetal status," previously known as fetal distress, is 

used to describe

 when a fetus does not appear to be doing well.

Non-reassuring fetal status 

may be linked to

:

1. an

irregular heartbeat in the

baby

2. problems

with muscle tone and movement

3. low

levels of 

amniotic fluid

causes :

-insufficient

oxygen levels

-maternal

 

anemia

-pregnancy-induced

 

hypertension

 in the mother

-intrauterine

growth retardation (IUGR)

-meconium-stained

amniotic fluid

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Management

1

.

Turn

the mother onto her side to correct any supine hypotension (a low blood pressure which some pregnant women can develop in late pregnancy when they lie flat on their back).

2 .If

the woman is receiving an oxytocin infusion, this must be stopped immediately to prevent any uterine overstimulation.

3. If

the fetal heart rate returns to normal, allow

labor

to proceed, but monitor the fetal heart rate very carefully and frequently. If possible, monitor with a CTG.

If the fetal

bradycardia

persists, the fetus must be delivered as soon as possible, which will be by Caesarean section in most cases. While preparing for Caesarean section, fetal resuscitation must be performed.

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3

.

Excessive bleeding

On average, women

loss

(

 

500

ml

)

 of blood during the vaginal delivery of a single baby.

single

baby,

during the first hour after delivery.

hemorrhage

result from a lack of uterine tone.

Bleeding happens after the placenta is expelled, because the uterine contractions are too weak and cannot provide enough compression to the blood vessels at the site of where the placenta was attached to the uterus.

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Risk factors:

-previous history of hemorrhage.

-labor augmented with oxytocin.

-multiple

gestation

pregnancy

-pregnancy-induced hypertension

-prolonged

labor

-the

use of forceps or a vacuum-assisted delivery

-use

of general anesthesia or medications to induce or stop labor

-infection

-obesity

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mangment

- assessment post delivery uterine contraction

-uterine massage

-

-removal

of retained

placenta

-

-assessment amount and color of vaginal bleeding

-monitor VS every 15 minute

-IV administration of oxytocin

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4

. Malposition

.

n

ot

all babies will be in the best position for vaginal delivery. Facing downward is the most common fetal birth position, but babies can be in other positions.

They 

include

:

-facing

upward

-breech

, either buttocks first (frank breech) or feet first (complete breech)

-lying

sideways, horizontally across the uterus instead of vertically

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Depending on the position of the baby and the situation, it may be necessary to

:

manually change the fetal

position

-

-use forceps

-carry

out an episiotomy, to surgically enlarge the opening

-perform

a

cesarian

delivery

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5

.Prolapsed umbilical cord

descend of the umbilical cord to the vagina before the presenting part

risk factor

-multiple pregnancy

-high presenting part

-polyhydramnios

-

malpresentation

-premature labor

-fetal abnormalities

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Management

1. use of

trendeleburgs

position

2. monitoring FHR

3. pushing of the head up and of the cord with a sterile gloved hand.

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6

.

Cephalopelvic

disproportion

Cephalopelvic

disproportion (CPD) is when a baby's head is unable to fit through the mother's

pelvis.

causes

:

-the

baby is large or has a large head

size

-the

baby is in an

unusual position

-the

mother's pelvis is small or has an unusual

shape.

A

ClS

delivery

will normally be necessary.

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MANAGEMENT

1. Increase pelvic diameter during labor by squatting, sitting ,rolling from side to side

2. maintaining knee-chest position ,use of labor ball

3. CPD may make

ClS

only available method of birth.

4. monitor maternal VS

5. Monitor FHR.

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7

.

Uterine rupture

If someone has previously had a

cesarian

delivery, there is a small chance that the scar could open during future labor.

If this happens, the baby 

may be at risk

 of oxygen deprivation and a

cesarian

delivery may be necessary. The mother may be at risk of excessive bleeding.

Apart from a previous cesarean delivery, 

other possible risk factors

 include:

-the

induction of

labor

-

-the size of the baby-maternal age of 35 years or more

-the

use of instruments in vaginal

delivery.

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Signs

-an

abnormal heart rate in the

baby

-abdominal

pain and

tenderness

in the mother

-slow

progress in labor

-vaginal

bleeding

-rapid

heart rate and low blood pressure in the

mother.

-hypovolemic shock in the woman, fetus, or

both.

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Nursing

management

,

1. delivery

by cesarean birth is indicated. The life-threatening nature of uterine rupture is underscored by the fact that the maternal circulatory system delivers approximately 500 mL of blood to the term uterus every minute (

Toppenberg

& Block, 2002). Maternal death is a real possibility without rapid intervention

.

2. Newborn

outcome after rupture depends largely on the speed with which surgical rescue is carried

out.

3.

Monitor maternal vital signs and observe for hypotension and tachycardia, which might indicate hypovolemic shock.

4. Assist

in preparing for an emergency cesarean birth by alerting the operating room staff, anesthesia provider, and neonatal

team.

5.

Insert an indwelling urinary (Foley) catheter if one isn’t in place already

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References

:

1. Clinical Practice Guidelines on

Intrapartum

and Immediate Postpartum Care 2012 by Department of Health and Philippine Obstetrical and Gynecological Society.

2. Callahan, T. (2013). 

Blueprints Obstetrics and Gynecology. 

(6

th

 ed.). Baltimore, MD: Lippincott William & Wilkins.

3.

Pillitteri

, A. (2010). 

Maternal & Child Health Nursing: Care of the Childbearing and Childrearing

Family

 (6th ed.). PA: Lippincott William & Wilkins.